JOURNAL OF CANADIAN HEALTHCARE ENGINEERING SOCIETY
SMART SOLUTION HealthcareFacilities Canadian
Sunnybrook’s newest facility consolidates supports, research for complex brain disorders AI HVAC optimization
FACILITY MANAGEMENT & DESIGN
20 Capitalizing on Lessons Learned North York General Hospital’s robust framework for effective project delivery in an existing healthcare facility
22 At Home in Hospital
Optimizing the patient care environment to enhance health outcomes, improve operational efficiency
EDITOR/RÉDACTRICE Clare Tattersall claret@mediaedge.ca
PUBLISHER/ Jake Blanchard ÉDITEUR DU GROUPE jakeb@mediaedge.ca
PRESIDENT/PRÉSIDENT Kevin Brown kevinb@mediaedge.ca
SENIOR DESIGNER/ Annette Carlucci CONCEPTEUR annettec@mediaedge.ca GRAPHIQUE SENIOR
GRAPHIC DESIGNER/ Thuy Huynh-Guinane GRAPHISTE roxyh@mediaedge.ca
PRODUCTION Ines Louis COORDINATOR/ inesl@mediaedge.ca COORDINATEUR DE DE PRODUCTION
CIRCULATION MANAGER/ Adrian Holland DIRECTEUR DE LA circulation@mediaedge.ca DIFFUSION
CANADIAN HEALTHCARE FACILITIES IS PUBLISHED BY UNDER THE PATRONAGE OF THE CANADIAN HEALTHCARE ENGINEERING SOCIETY.
SCISS JOURNAL TRIMESTRIEL PUBLIE PAR SOUS LE PATRONAGE DE LA SOCIETE CANADIENNE D'INGENIERIE DES SERVICES DE SANTE.
CHES SCISS
PRESIDENT Jim McArthur
VICE-PRESIDENT Kate Butler
PAST PRESIDENT Craig B. Doerksen
TREASURER Reynold J. Peters
SECRETARY Paul Perschon
14 A Mindful Expansion at Sunnybrook Une expansion réfléchie à Sunnybrook
SUSTAINABLE HEALTHCARE
26 Long-term Care of the Planet Building materials play role in mitigating embodied carbon in healthcare facilities
30 An Astute Idea
How artificial intelligence can be used to enhance HVAC efficiency
Reproduction or adoption of articles appearing in Canadian Healthcare Facilities is authorized subject to acknowledgement of the source. Opinions expressed in articles are those of the authors and are not necessarily those of the Canadian Healthcare Engineering Society. For information or permission to quote, reprint or translate articles contained in this publication, please write or contact the editor.
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EXECUTIVE DIRECTOR Tanya Hutchison
CHAPTER CHAIRS
Newfoundland & Labrador: Colin Marsh
Maritime: Steve Smith
Ontario: John Marshman
Quebec: Mohamed Merheb
Manitoba: Stephen R. Cumpsty
Saskatchewan: Melodie Young
Alberta: James Prince
British Columbia: Mitch Weimer
FOUNDING MEMBERS
H. Callan, G.S. Corbeil, J. Cyr, S.T. Morawski
CHES
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La reproduction ou l’adaptation d’articles parus dans le Journal trimestriel de la Société canadienne d’ingénierie des services de santé est autorisée à la condition que la source soit indiquée. Les opinions exprimées dans les articles sont celles des auteurs, qui ne sont pas nécessairement celles de la Société canadienne d’ingénierie des services de santé. Pour information ou permission de citer, réimprimer ou traduire des articles contenus dans la présente publication, veuillez vous adresser à la rédactrice.
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A NEW ERA OF BRAIN HEALTH
IN 2024, for the sixth consecutive year, Sunnybrook ranked No. 2 in Canada, and No. 30 worldwide in Newsweek’s annual world’s best hospitals ranking. The ranking is based on three data sources: hospital recommendations from peers, patient experience and medical key performance indicators on hospitals, such as data on quality of treatment and hygiene measures.
In only weeks’ time, the three-campus hospital will learn if it made the prestigious list again; however, its primary focus right now is the opening of the new Garry Hurvitz Brain Sciences Centre. Slated for the first month of 2025, the recently completed three-storey facility is dedicated to connecting those with complex brain disorders and mental health conditions to the care they need. Its claim to be the first-of-its-kind centre in this country that integrates patient care and interdisciplinary research, emphasizing a unified approach to mental and physical health treatment, is among the reasons the project was chosen to be this issue’s feature.
Next, a presenter at the most recent CHES National conference, Rudy Dahdal, shares lessons learned in implementation of capital projects at North York General Hospital in Toronto, while maintaining full facility operations. He also introduces a framework that provides project teams with tools for effective and efficient project delivery. Then, a second conference presenter, Barry Hunt, delves into how healthcare facilities can empower patients and give them control over their visit to improve their hospital experience.
Rounding out this issue is the topic of sustainability. Long-term care of the Planet explores how healthcare facilities provide an excellent typology for dramatic embodied carbon reductions, while An Astute Idea explores how artificial intelligence can be used to harness free energy to optimize heating, ventilation and air conditioning efficiency.
Clare Tattersall claret@mediaedge.ca
SAVE THE DATE!
The 2025 CHES National Conference will be held in Calgary, Alberta, at the BMO Centre-Stampede Park, September 14-16, 2025. BMO Centre-Stampede Park is conveniently located in the downtown core and close to local amenities.
The theme of the 2025 conference is “Transforming Healthcare Together: Empowering Teams, Inspiring Creativity, Unleashing Knowledge”
The CHES 2025 Education Program is well underway and will once again feature dual tracks with talks on relevant industry topics from high-profile experts in the field.
We are excited to announce our keynote speaker is Ross Bernstein He's a best-selling author of nearly 50 sports books, a peak-performance business speaker and proud member of the Speaker Hall of Fame who will get us all thinking differently about how we can raise our game to the next level
There are plenty of social activities to network! The Great CHES Golf Tournament is tentatively scheduled to take place at the Kananaskis Country Golf Course on Sunday, September 14, 2025.
Join us for the CHES President’s Reception and Gala Banquet again in 2025 at BMO CentreStampede Park The banquet will celebrate the accomplishments of our peers with the 2025 Awards presentations, while enjoying great food and entertainment with friends.
A block of rooms has been reserved at the Calgary Marriott Downtown and there is a conference rate of $245 single/double, plus applicable taxes.
YEARLY ROUNDUP
WITH WINTER upon us, I am reminded of the challenges we face as healthcare facility managers in dealing with weather extremes and keeping our facilities safe and comfortable. Somehow, we seem to manage the performance and safety of our facilities under continual budget restrictions and staffing issues.
Although the CHES National executive meets on a monthly basis, the first meeting under the new board was held this past December. The board meets quarterly and includes the CHES National executive, chapter chairs and committee chairs, as well as our executive director from Events & Management Plus Inc.
We continue to develop collaboration opportunities with other organizations, including Infection Prevention and Control Canada, the American Society for Healthcare Engineering and Canadian College of Health Leaders, among others. The purpose is to enhance offerings to our membership.
Past president Craig Doerksen and I attended the 2024 International Federation of Healthcare Engineering (IFHE) Congress in Cape Town, South Africa, in October. We reacquainted with our colleagues from around the globe, many of whom attended the IFHE congress in 2022, when CHES hosted the event in Toronto. At the 2024 congress, we were honoured to accept IFHE Global Energy Awards on behalf of two Canadian hospitals: Holy Family Hospital in British Columbia, and Cortellucci Vaughan Hospital in Ontario. Congratulations to both healthcare facilities on the achievement.
Following the IFHE congress, I attended CHES Saskatchewan’s conference in Regina, and CHES Newfoundland and Labrador’s conference in St. John’s. Both events were well-attended. Kudos to each chapter’s conference planning committee.
I look forward to attending various chapter events in spring, as well as the 2025 CHES National Conference in Calgary, Sept. 14-16. Be sure to mark this must-attend event on your calendar.
As we embark on a new year, I’d like to thank all CHES members for everything you do to make our healthcare facilities operational, safe and comfortable for all who enter.
Jim McArthur CHES National president
EARN CONTINUING EDUCATION CREDITS FROM CHES
Members of the Canadian Healthcare Engineering Society can earn free continuing education units (CEU) by reading the Winter 2024/2025 issue of Canadian Healthcare Facilities and passing a quiz based on articles in the issue. Once you’ve read the issue from cover to cover, simply go online to https://www.surveymonkey.com/r/LTZ55DB to take the quiz. CHES members who pass the quiz will be able to claim one contact hour (0.1 CEU) on their CanHCC or CCHFM certificate renewals.
BRITISH
COLUMBIA CHAPTER
The B.C. chapter was busy this past fall. We convened our conference committee in September, and added more people for succession planning as well as to assist with making some major changes to our conference planning process. We were asked by the CHES National office to divest ourselves from the national platform for conference registration and payment. So, we engaged with a third-party registration platform to handle these duties. A lot of work was required to set up and test the systems. CHES B.C. vice-chair Doug Davis took on the role of conference chair. His help with the conference put us ahead of schedule. Conference registration opened Nov. 25, three weeks earlier than normal. Sixty-five exhibitor booths were secured within the first 24 hours. I’d like to thank CHES executive director Tanya Hutchison for completing the B.C. chapter’s conference page on the CHES website.
The B.C. chapter hosted a sold-out Canadian Healthcare Construction Course Nov. 14-15, in Surrey. Feedback from attendees was positive. We are currently working with the CHES National office to secure dates and a facility for November 2025.
CHES B.C. is working through the process of incorporating. We are hoping the chapter will be incorporated in early 2025. However, we have hit a fairly significant roadblock between the wishes of the CHES National executive and the requirements of our chapter bylaws. We have engaged a small working team to determine whether we are able to find a solution to this impasse. Adoption of the new bylaws may require a special meeting of the chapter.
CHES B.C. has a number of perpetual education bursaries at various provincial post-secondary institutions to help the next generation with their education goals. The chapter also has an education tuition grant that offers up to $1,000 toward member education. Check out the B.C. chapter page on the CHES website for more information.
—Mitch Weimer, British Columbia chapter chair
SASKATCHEWAN CHAPTER
CHES Saskatchewan had a very successful 2024 fall conference and trade show, with 65 delegates in attendance. There were a number of new and returning vendors and sponsors. Session topics were well-received and included trends in construction contracting, infection control in a multidisciplinary environment, de-carbonization and building code issues in existing facilities. One of the more intriguing sessions was about the Nest Health Centre in Regina, where patients can receive end-toend medical care in one place. Opened in 2023, it offers modern and holistic approaches to medicine in a collaborative delivery model.
During the conference, the chapter held its annual general meeting. Vacant spots on the chapter executive were filled. We now have a full complement of committee members. I would like to extend a warm welcome to all those on the executive team, both returning and new members. I look forward to the year ahead as we continue our commitment to CHES Saskatchewan.
—Melodie Young, Saskatchewan chapter past chair
MARITIME CHAPTER
Overall, feedback on the 2024 CHES National Conference has been very positive. I’d like to thank all those involved in making the conference a truly successful and positive event. I also want to congratulate the Maritime chapter executive on its President’s Award win, bestowed at the conference. Their dedication and hard work resulted in achieving this award two years in a row.
The chapter executive decided to postpone our 2024 fall education day, which is typically held in November, until 2025. The executive expected it might not be well-attended given members had opportunities to attend both the Maritime chapter education day in May, and the CHES National conference in September. As well, the executive acknowledged the significant and recent efforts put in to support a successful national conference, and recognized planning needed to focus on the upcoming Maritime spring conference to be held May 4-6, at the Delta Beausejour hotel in Moncton, N.B.
CHES Maritime is planning to host the Canadian Healthcare Construction Course in Halifax, Oct. 22-23.
The Maritime chapter continues to offer several financial incentives to members, such as the Per Paasche bursary, contribution to Canadian Certified Healthcare Facility Manager exam fees, spring and fall education days, and other membership benefits.
—Steve Smith, Maritime chapter chair
MANITOBA CHAPTER
Planning continues for the Manitoba chapter’s spring education day to be held April 15, at the Victoria Inn Hotel and Convention Centre in Winnipeg. The theme: Navigating Aging Infrastructure. Sponsors are being sought and topics for presentations are well underway. The full agenda is expected to be ready in early 2025.
CHES Manitoba sponsored an education session at the 2024 Manitoba Building Conference and Expo. Sixty chapter members attended The education session was about infection prevention and control (IPAC) in renovation and construction, presented by Southern Health’s Paula Enns and Marcel Bedard. I presented a short slide show on CHES and the Canadian Healthcare Construction Course (CanHCC). For 2025, the chapter executive is contemplating conducting a joint training conference with IPAC Manitoba.
The Manitoba chapter hosted the CanHCC Nov. 28-29, in Winnipeg. Thirty people signed up to attend the session.
A delegation from Manitoba went to the 2024 CHES National Conference in Halifax. It included myself, chapter vice-chair Kevin Shmon, Jeremy Kehler, chair of the CHES National professional development subcommittee, CHES National treasurer Reynold Peters and now CHES National past president Craig Doerksen. Mike Reader, director of capital and facilities management for the Northern Regional Health Authority, attended as the trip winner from our spring 2024 education day.
—Stephen R. Cumpsty, Manitoba chapter chair
QUEBEC CHAPTER
As one year gives way to the next, it’s an opportune time to reflect on the milestones achieved by the Quebec chapter in 2024. The year was transformative, marked by several noteworthy events. In May, we hosted our first-ever chapter conference, which was followed in June by the inaugural Canadian Healthcare Construction Course (CanHCC), made possible through collaboration with the Quebec Construction Association (ACQ). Most recently, on Nov. 20, we held a conference dinner highlighting the use of artificial intelligence (AI) in healthcare facilities. This compelling topic drew a motivated audience eager to explore the profound impact of AI on daily operations.
Quebec’s healthcare network is embarking on its most significant restructuring to date with the establishment of Quebec Health Services. As of Dec. 1, 2024, all health authorities and regions now report to a single employer, marking a historic shift. CHES is committed to engaging with this new centralized entity to build relationships that will enhance the working conditions and professional development of healthcare facility workers across the province.
Looking ahead, I am thrilled to announce our 2025 chapter conference will take place May 7, in Montreal. It promises to be an exceptional gathering. Additionally, the Quebec chapter is collaborating once again with ACQ to prepare for the next offering of the CanHCC, scheduled for summer.
Our vision for the future centres on expanding the chapter’s reach and influence within the field of healthcare engineering. Membership growth remains a top priority, as it is key to amplifying our impact. To support this, we are leveraging social media platforms like LinkedIn and Instagram to foster dynamic communication channels. These efforts aim to keep members informed, engaged and connected with the chapter’s latest initiatives and events.
Your continued support and active participation are the cornerstone of the chapter’s success. I am confident our collective efforts will lead to even greater accomplishments in 2025.
—Mohamed Merheb, Quebec chapter chair
CHAPITRE DU QUEBEC
Alors que nous approchons de la fin de l’année, il est opportun de revenir sur les réalisations marquantes du chapitre québécois de la SCISS en 2024. Cette année a été transformative, ponctuée de plusieurs événements significatifs. En mai, nous avons organisé notre toute première conférence de chapitre, suivie en juin par le lancement du premier Canadian Healthcare Construction Course (CanHCC), rendu possible grâce à une collaboration avec l’Association de la construction du Québec (ACQ). Plus récemment, le 20 novembre, nous avons tenu un dînerconférence portant sur l’utilisation de l’intelligence artificielle (IA) dans les établissements de santé. Ce sujet captivant a attiré un public motivé à explorer l’impact considérable de l’IA sur les opérations quotidiennes. À partir du 1er décembre 2024, le réseau de santé québécois amorce sa plus grande restructuration historique avec la création de Santé Québec. Toutes les autorités et régions de santé relèveront désormais d’un seul employeur, marquant une transformation majeure. Dans ce contexte, la SCISS s’engage à établir des relations avec cette nouvelle entité centralisée pour renforcer les conditions de travail et le développement professionnel des employés des établissements de santé à travers la province. En regardant vers 2025, nous sommes ravis d’annoncer que notre prochaine conférence de chapitre se tiendra à Montréal le mercredi 7 mai 2025. Par ailleurs, nous collaborons à nouveau avec l’ACQ pour préparer la prochaine édition du CanHCC, prévue pour l’été 2025. Notre vision pour l’avenir se concentre sur l’expansion de l’influence et de la portée du chapitre au sein du domaine de l’ingénierie des soins de santé. La croissance de notre adhésion demeure une priorité, car elle est essentielle pour amplifier notre impact. Pour soutenir cet objectif, nous exploitons des plateformes de médias sociaux telles que LinkedIn et Instagram afin de créer des canaux de communication dynamiques. Ces efforts visent à tenir nos membres informés, engagés et connectés à nos dernières initiatives et événements. Votre soutien continu et votre participation active sont les piliers de notre succès. Alors que nous nous préparons à l’année à venir, je suis convaincu que nos efforts collectifs mèneront à des réalisations encore plus grandes. Merci, et j’ai hâte de voir ce que nous accomplirons ensemble en 2025.
—Mohamed Merheb, chef du conseil d’administration du Québec
The 2025 CHES National Conference will be held in Calgary, Sept. 14-16, at BMO Centre in Stampede Park.
NEWFOUNDLAND & LABRADOR
CHAPTER
Some of the dust is settling on the amalgamation of the four former health authorities to one provincial health authority. While there are still hurdles to overcome, we are moving forward.
The chapter executive decided to push back the date of our annual conference in 2024, to fall from spring because Infection Prevention and Control Canada’s national conference was scheduled for June in St. John’s. Our conference was held in early November, and it was the largest in the province to date, with the greatest number of attendees and the most vendor display booths ever. We had excellent attendance from all newly formed health zones under Newfoundland and Labrador Health Services.
November ended up being an ideal month to host our conference so we’re planning to hold the 2025 conference around the same time. Right now, it’s tentatively scheduled for late October, though that’s subject to change. We had to turn away vendors and presenters in 2024, due to space constraints, so we are looking into finding a different venue, which will allow for additional registrants. We also may add a day for training and hands-on activities.
The chapter is sitting in a solid financial position. Given this, we will be sending chapter executive members to Calgary for the 2025 CHES National Conference to promote the 2026 CHES National Conference, which will be held in St. John’s. Over the coming months, we will be seeking members to sit on the planning committee for the 2026 event.
—Colin Marsh, Newfoundland & Labrador chapter chair
ALBERTA CHAPTER
CHES Alberta’s membership numbers continue to be impacted by spending restrictions imposed by Alberta Health Services. Despite these challenges, we remain committed to supporting our members and finding ways to engage and grow our community. Recent talks with the Northern Alberta Institute of Technology promise greater student awareness of our society. Further discussions are planned with other technical schools.
Several planning committee members, along with CHES National president Jim McArthur, recently visited venues selected for the 2025 CHES National Conference. The venues, including hotel, opening ceremony location and BMO Centre — site of the main event — are highly impressive. There is great potential for this to be the biggest event CHES has ever seen in Alberta. Subcommittees are actively being formed and significant progress is being made in planning the conference. I am confident that with the dedication and hard work of volunteers, the conference will be a resounding success.
The chapter executive has commenced conversations with local technical colleges to renew CHES Alberta’s bursary contributions. This initiative aims to support and encourage the next generation of healthcare engineers.
On behalf of the CHES Alberta executive, I appreciate the continued efforts of all chapter members and volunteers during these challenging times. Together, we will continue to advance the field of healthcare engineering in the province.
—James Prince, Alberta chapter chair
CHES SCISS
Canadian Healthcare Engineering Society Société canadienne d'ingénierie des services de santé
CALL FOR GRANT SPONSORSHIP & SUBMISSIONS
2025 Young Professionals Grant
DEADLINE: April 30, 2025
CHES is seeking both sponsors and candidates for the 2025 Young Professionals Grant. The application forms for Sponsors and Candidates are available on the CHES Website.
Call for Sponsors:
• The YPG sponsorship application form must be completed by the sponsoring organization/company and submitted to the CHES National Office.
• CHES National Office will invoice sponsoring organization/company for $2,500 once candidate applications have been received and approved.
Call for Candidates:
• Young professionals who are or will become architects, engineers (i.e. mechanical, electrical, power, and civil, etc.), technicians or similar technical disciplines are eligible.
• Eligible candidates are those working within a healthcare organization or a company supplying goods or services to healthcare facilities or organizations.
• Eligible candidates must be working in the healthcare field for less than 5 years.
• The YPG application form must be completed by the eligible candidate and submitted to the CHES National Office. In this form, the eligible candidate will be required to provide information on their recent employment and future career aspirations.
• Confirmed candidates will receive complimentary registration for the 2025 National Conference and complimentary membership for the remainder of the 2025-2026 membership year.
For Nomination Forms, Terms of Reference, criteria and past winners www.ches.org / About CHES / Awards
Send nominations to: CHES National Office info@ches.org
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A MINDFUL EXPANSION AT SUNNYBROOK
Une expansion réfléchie à Sunnybrook
By/Par Rebecca Melnyk
Amid the high-traffic frenzy of Sunnybrook Health Sciences Centre, which houses the busiest trauma facility in Canada, a new space brings peace and comfort to patients with brain and mental health needs and the staff who care for them.
Although it’s sandwiched into an extremely dense urban site, one of the few vacant spots left on the hospital grounds, the Garry Hurvitz Brain Sciences Centre offers views of Toronto’s Burke Brook ravine, access to three therapeutic gardens and courtyards, and is completely infused with natural light.
“When you first come in, you have a much more calming environment than (being) in the hustle and bustle of an acute trauma centre,” says Barbara Miszkiel, vice-president and director of HDR Architecture’s health practice in Eastern Canada.
The HDR design team was tasked with creating a healing space that combines mental health care and innovative research under one roof, while bringing together interdisciplinary healthcare teams from
Un hâvre de paix émerge au milieu du Centre des sciences de la santé Sunnybrook. Ce nouvel espace apporte réconfort aux patients souffrant de troubles mentaux et neurologiques, ainsi qu’au personnel soignant. Il tranche avec l’effervescence habituelle de l’établissement, qui abrite le service de traumatologie le plus fréquenté du Canada.
Le Centre des sciences du cerveau Garry Hurvitz se dresse sur l’un des derniers espaces libres du terrain hospitalier. Malgré son implantation dans un tissu urbain très dense, il offre des vues sur le ravin Burke Brook de Toronto. Trois jardins thérapeutiques et des cours intérieures agrémentent le bâtiment. La lumière naturelle y pénètre abondamment.
“Dès votre entrée, un environnement apaisant vous accueille, en net contraste avec l’agitation habituelle d’un centre de soins aigus,” souligne Barbara Miszkiel. Cette vice-présidente dirige la division santé Est du Canada chez HDR Architecture.
across the brain sciences field. The entrance was flipped backwards to face the ravine and orient the building away from traffic and parking, unlike other main entrances to the hospital, and features a doubleheight space wrapped in translucent zinc cladding. Psychiatric emergency patients can, in turn, access the building from the other side for discretion and clinical purposes.
Completed this past October, the four-storey, 118,285-square-foot facility accommodates three distinct inpatient mental health units for adults and youth on the ground floor, totalling 38 beds, another small unit on the second floor and a psychiatric intensive care unit (PICU), all with their own dedicated exterior courtyard. The upper levels are home to an adolescent inpatient unit, a youth bipolar disorder unit, sleep clinics, neuromodulation, a dedicated roof garden, a youth ‘fresh start’ program for people reentering society, and spaces to advance the research of brain disorders and illness, including dementia, Amyotrophic lateral sclerosis (ALS) and eating disorders.
L’équipe HDR avait une mission ambitieuse: concevoir un lieu de guérison unique. Cet espace devait allier soins de santé mentale et recherche de pointe sous un même toit. Il devait aussi rassembler des équipes interdisciplinaires spécialisées dans les sciences du cerveau. Contrairement aux autres entrées de l’hôpital, celle-ci fait face au ravin. Ce choix l’éloigne de l’agitation du parking et de la circulation. Un hall à double hauteur, paré d’un revêtement en zinc translucide, accueille les visiteurs. Pour préserver leur intimité et répondre à leurs besoins cliniques, les patients psychiatriques en situation d’urgence disposent d’un accès distinct, de l’autre côté du bâtiment.
Le Centre des sciences du cerveau Garry Hurvitz, inauguré en octobre dernier, s’étend sur quatre étages et 11000 mètres carrés. Au rez-de-chaussée, on trouve trois unités de santé mentale distinctes pour adultes et jeunes, totalisant 38 lits. Chacune de ces unités est dotée de sa propre cour extérieure. Le deuxième étage abrite une petite unité et une unité de soins psychiatriques intensifs. Les étages
Renderings courtesy HDR Architecture Associates Inc.
tHalf of the building is dedicated to inpatients. Director of capital development at Sunnybrook Anton Rabindran, who helped oversee construction, says the inpatient population is moving into private bedrooms with three-piece ensuite washrooms and exterior views. In place of a single multi-purpose group room, patients have a dedicated gym, group spaces and areas for assisted daily living with activities. Their outdoor space is bounded by glass walls, which they can access directly from the inpatient units themselves.
“For patients to get any fresh air, they have to travel outside their building with staff assistance and monitoring,” says Rabindran. “Now they can easily go outside and the nurses watch them through video cameras and talk to them through intercoms. That’s pretty trailblazing.”
Miszkiel adds that many patients, particularly those with anxiety, cope better in smaller settings. Because of this, inpatient units were designed for smaller social groupings, with spaces to pace in the PICU and an outdoor courtyard to help mitigate anxiety and aggression and calm down.
“Patients with lived experience who have been through care and treatment in mental health facilities have a diverse group of challenges they’ve been managing and living with for a long time,” she says. “We use evidence-based research together with an empathic approach to design for diverse patient needs”
supérieurs accueillent une variété de services: une unité d’hospitalisation pour adolescents, une unité pour les troubles bipolaires chez les jeunes, des cliniques du sommeil, un service de neuromodulation, un jardin thérapeutique sur le toit, un programme de réinsertion sociale pour les jeunes, ainsi que des espaces dédiés à la recherche sur les troubles et maladies du cerveau, notamment la démence, la sclérose latérale amyotrophique et les troubles alimentaires.
La moitié du bâtiment accueille les patients hospitalisés dans des chambres individuelles. Ces dernières offrent une salle de bain privée et une vue sur l’extérieur, précise Anton Rabindran, directeur du développement des immobilisations de Sunnybrook. Au lieu d’une unique salle commune polyvalente, les patients bénéficient d’espaces dédiés: une salle de sport, des zones communes et des aires pour les activités quotidiennes assistées. Ils ont également un accès direct à un espace extérieur sécurisé, entouré de murs de verre, depuis leurs unités d’hospitalisation.
Anton Rabindran explique l’évolution novatrice des sorties des patients: “Auparavant, le personnel devait accompagner et surveiller les patients hors du bâtiment pour qu’ils prennent l’air. Désormais, ils sortent aisément tandis que les infirmières les observent par caméras et communiquent avec eux via des interphones. Cette approche est véritablement révolutionnaire.”
LEFT TO RIGHT: The main entrance is grounded with a light-infused, double-height lobby that separates inpatient and public flow for efficiency in care and intuitive paths for visitors. The ground floor includes direct access to secure exterior therapeutic courtyards for both adult and adolescent patients.
HEALTHCARE DEVELOPMENT
LIVED EXPERIENCE INFORMS DESIGN
To better address different acuities through design, the Hurvitz Brain Sciences program’s patient family advisory council (PFAC) was involved from day one.
“I’ve been at Sunnybrook a very long time and this was my first project that had PFAC membership on my design table,” says Rabindran. “It proved to be a fantastic move. They brought the human element to architects, consultants and myself, who sometimes have never been in that situation.”
PFAC members are still involved as the team orders furniture and finishes.
“What came from the user process was the notion that first impressions are important,” says Miszkiel. “When people are coming in a more fragile state, the whole idea is for the space to not be overwhelming but comforting so it doesn’t feel like you’re in a hospital. We reflected that in the designs, particularly in the main entrance and lobby.”
One idea that sprouted was bench seating for inpatient units along the corridors.
“We don’t treat corridors as just a way of getting from point A to point B; the corridors are also therapeutic spaces,” says Miszkiel. “In mental health facilities, it’s very important for patients to be able to sit on a threshold and watch the world go by. They can choose to
Miszkiel souligne pour sa part que les espaces plus intimes conviennent mieux à de nombreux patients, surtout ceux souffrant d’anxiété. C’est pourquoi les unités d’hospitalisation accueillent des groupes sociaux restreints. L’unité de soins psychiatriques intensifs offre des espaces de déambulation et une cour extérieure. Ces aménagements visent à apaiser l’anxiété et l’agressivité des patients.
“Les patients ayant reçu des soins en santé mentale font face à de nombreux défis. Ils gèrent ces difficultés depuis longtemps,” explique Miszkiel. “Nous concevons des solutions adaptées à leurs besoins variés. Pour cela, nous combinons la recherche scientifique et une approche empathique.”
L’EXPÉRIENCE GUIDE LA CONCEPTION
Le conseil consultatif des familles de patients (CCFP) du programme Hurvitz en sciences du cerveau a participé dès le départ. Son implication visait à mieux adapter la conception aux divers degrés de gravité des cas.
“Je travaille à Sunnybrook depuis très longtemps, mais c’était la première fois que je collaborais avec des membres du CCFP dans un projet de conception,” explique Rabindran. “Cette décision s’est révélée excellente. Ils ont apporté une dimension humaine à notre équipe d’architectes et de consultants. Leur expérience nous a éclairés, nous qui n’avons parfois jamais vécu ces situations.”
Les membres du CCFP sont toujours impliqués dans la commande des meubles et des finitions.
“La consultation des utilisateurs a mis en lumière l’importance cruciale des premières impressions,” souligne Miszkiel. “Notre objectif était de créer un espace réconfortant, loin de l’atmosphère intimidante d’un hôpital traditionnel. Cette approche visait à rassurer les personnes arrivant dans un état de vulnérabilité. Nous avons traduit cette vision dans nos designs, en particulier pour l’entrée principale et le hall d’accueil.”
L’installation de bancs dans les couloirs des unités d’hospitalisation a émergé comme une idée prometteuse.
“Les couloirs ne sont pas de simples passages entre deux points. Ils font partie intégrante de l’espace thérapeutique,” souligne Miszkiel. “Dans les établissements psychiatriques, les patients doivent pouvoir s’asseoir et observer le va-et-vient. Cela leur permet de choisir entre participer à une activité ou simplement observer. Progressivement, ils se sentiront plus à l’aise pour accepter davantage de soins.”
Les maquettes d’aménagement ont inspiré la conception des chambres, alliant confort et sécurité. Auparavant, les infirmières devaient allumer la lumière toutes les 15 minutes pour observer les patients, les réveillant ainsi en pleine nuit. Désormais, six zones d’éclairage au-dessus de la porte créent une ambiance de veilleuse, plus douce.
Pour préserver l’intimité des patients, des stores équipent chaque porte et fenêtre. Les patients peuvent les ajuster à leur guise. Depuis le couloir, le personnel soignant peut ouvrir ces stores pour vérifier l’état des patients.
Une autre demande du CCFP, et une première à Sunnybrook, est de permettre aux patients de verrouiller leur propre porte.
“De nombreux patients apportent leurs effets personnels lors de longs séjours, craignant les vols,” explique Rabindran. “Ils peuvent verrouiller leur porte de chambre d’un simple bouton, empêchant l’entrée des autres patients. Le personnel, lui, peut toujours accéder à la chambre grâce à son insigne.”
UNE CLINIQUE MOBILE
Les soins ambulatoires occupent l’autre moitié du bâtiment, avec 26
participate in a program or observe and gradually feel comfortable with accepting more treatment.”
For the rooms themselves, the input that came from mock-ups of bedroom layouts inspired design choices that combine comfort with safety and security. Since nurses must check on patients every 15 minutes, they would traditionally flip on a light switch in the middle of the night, waking everyone. Now, there are six lighting zones in the room above the doorway that offer more of a nightlight feel.
For privacy, patients can modulate blinds attached to every door and window. Staff on the corridor side can open the blinds to make sure patients are faring well.
Another PFAC request, and a first at Sunnybrook, was allowing patients to lock their own door.
“A lot of these patients bring their belongings with them because they stay awhile and are afraid of theft,” says Rabindran. “When they’re in their room, they can press a button on their wall to lock the doors so their neighbour can’t get in. Any staff member can override that with their badge.”
A ROTATING CLINIC
Outpatient care defines the other half of the building, with 26 exam rooms that act as a weekly rotating clinic for different service providers who focus on areas like stroke and dementia. Half of the rooms are specifically designed for ALS patients who have the greatest needs. Six will be used for sleep studies at night. As well, two circadian sleep rooms — the only ones in Ontario — feature high levels of attenuation and a sequence of doors that trap out the light. They are dedicated to people with severe sleep issues who can rest in darkness and silence to reset their internal clocks.
A neuromodulation centre is also equipped to offer electroconvulsive therapy (ECT) and repetitive transcranial magnetic stimulation (rTMS or TMS), which is an up-and-coming procedure that uses magnetic pulses to stimulate the brain’s nerve cells. This helps people with severe medication and treatment-resistant mental health disorders.
MODERN VISION AND FUTURE EXPANSION
The Garry Hurvitz Brain Sciences Centre has been 10 years in the making since its namesake, a local entrepreneur and philanthropist, kick-started the project with a $20-million donation back in 2014, with the province investing $60 million.
The building will grow over time as more funding becomes available. Since it cannot expand horizontally, it was designed to add another four storeys on top. The team even acquired a green roof permit from the City of Toronto that approved its transfer to an upper level in the future.
One day, the expansion will also connect the structure to the main hospital circulation spine within its network-like campus of 20 buildings. As it stands, care teams are able to move through the whole complex, except one standalone facility, without ever stepping outside.
For now, the centre will begin delivering care to patients in January 2025. When it does, it’s expected to transform brain and mental health care in Ontario, and set a standard for designing such spaces.
“It’s about creating a really positive environment for both staff and patients, and making them feel like they are the most important person when they enter and that the care and treatment is about fostering independence and choice,” says Miszkiel. “Encouraging that is a way forward.”
salles d’examen qui servent de clinique à rotation hebdomadaire pour différents prestataires de services spécialisés dans des domaines comme l’AVC et la démence. La moitié des salles sont adaptées aux patients atteints de SLA ayant des besoins importants. Six salles servent aux études du sommeil nocturnes. Deux salles uniques en Ontario, dédiées au sommeil circadien, offrent une isolation sonore poussée et un système de portes bloquant la lumière. Ces dernières permettent aux personnes souffrant de troubles graves du sommeil de se reposer dans l’obscurité et le silence pour réguler leur rythme biologique.
Le centre de neuromodulation propose aussi la thérapie électroconvulsive (TEC) et la stimulation magnétique transcrânienne répétitive (SMTr). Cette dernière, une technique novatrice, utilise des impulsions magnétiques pour stimuler les cellules nerveuses cérébrales. Elle vise à soulager les personnes atteintes de troubles mentaux graves et résistants aux traitements classiques.
VISION MODERNE ET EXPANSION FUTURE
Le Centre des sciences du cerveau Garry Hurvitz est en gestation depuis une décennie. Le projet a démarré en 2014 grâce à un don de 20 millions de dollars de son homonyme, un entrepreneur et philanthrope local. La province a complété le financement avec un investissement de 60 millions de dollars.
Le bâtiment s’agrandira progressivement, au rythme des financements. Faute d’extension horizontale possible, sa conception prévoit l’ajout de quatre étages supplémentaires. L’équipe a même obtenu de la Ville de Toronto un permis de toit vert transférable aux niveaux supérieurs futurs.
À l’avenir, l’expansion reliera la structure à l’artère principale du campus hospitalier, un réseau de 20 bâtiments. Actuellement, les soignants circulent dans presque tout le complexe sans sortir, à l’exception d’une installation indépendante.
Le centre ouvrira ses portes aux patients en janvier 2025. Il ambitionne alors de révolutionner les soins en santé mentale et neurologique en Ontario. Sa conception novatrice devrait servir de modèle pour de futurs établissements similaires.
“Notre objectif est de créer un environnement positif pour tous, patients comme personnel,” conclut Miszkiel. “Chaque personne qui entre doit se sentir importante. Les soins visent à promouvoir l’autonomie et le libre choix. C’est la voie à suivre.”
Neurology services on the second floor are infused with warm colours and wood interiors.
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CAPITALIZING ON
LESSONS LEARNED
North York General Hospital’s robust framework for effective project delivery in an existing healthcare facility
By Rudy Dahdal
Over the past six years, North York General Hospital (NYGH) has undergone significant renovations, as part of the organization’s focus on renewing its facilities and enhancing the patient, family and staff experience. Needless to say, construction projects in fully operating hospitals are amongst the most challenging of projects, particularly in older buildings, where there’s likely to be unforeseeable site conditions along with other surprises during the course of construction. While some surprises cannot be avoided, having solid project management processes and prac-
tices help mitigate challenges and risks, and will undoubtedly result in better project outcomes.
The recent completion of several capital projects at NYGH and the imminent approval of other larger projects have promoted the need to formalize internal project management processes to ensure smooth project delivery and drive better outcomes. A retrospective analysis of completed projects has identified a number of key lessons learned in implementation of capital projects while maintaining full hospital operations. These learnings have re-emphasized the need to reset and refocus
on basic project management 101 principles, with prime focus on clearly defining project parameters, active governance, and effective communication and stakeholder engagement in all phases of the project.
Key pillars of this framework include scope definition and control; design reviews and approvals; quality control of construction documents; budget development and control; project governance; and communication and transparency.
SCOPE DEFINITION AND CONTROL
A well-defined project charter developed at
the inception of every project will document its objectives and parameters, including scope, budget, schedule and out-of-scope area, as well as risks and mitigating strategies. This ensures the project team plans and delivers a project with clearly defined and pre-approved parameters, and any deviations from such parameters are flagged to and managed by project sponsors.
DESIGN REVIEWS AND APPROVALS
All project stakeholders (clinical programs, infection prevention and control, occupational health and safety, digital, facilities, support services, security, foundation, patient experience partners) participate in a formal design review and sign-off meetings of the schematic design, design development and pre-tender package. This measure ensures stakeholders are fully informed of scope details. It is also meant to enhance accountability and reduce the need for design and scope changes during or post-construction.
QUALITY CONTROL OF DOCUMENTS
To ensure construction documents issued for cost estimates or to tender are as comprehensive, accurate and coordinated as possible, project schedules incorporate an appropriate investigation period, at times guided by preconstruction services of a constructor, as well as sequential steps of design reviews and approvals by content experts and stakeholders. This measure ensures higher quality of construction packages issued for costing and tender. It also reduces the likelihood of significant gaps in costing versus tendered pricing related to design changes and ultimately reduces the likelihood of change orders.
BUDGET MANAGEMENT
A robust methodology of budget development and control is a key success factor in project
delivery. The process utilizes cost consultant estimates as only one of several tools to develop a comprehensive project budget that is aligned to the scope and guided by appropriate level of preconstruction investigations of areas in scope. Factors such as type and complexity of the project, the site under development, phasing plan, historical performance on soft costs like furniture, information technology and equipment, and an appropriate contingency are all critical factors in developing an accurate budget.
PROJECT GOVERNANCE
All projects require a defined governance structure. A project steering committee (size and membership project-specific) has responsibility for oversight of project delivery from inception to closeout. The governance structure also clarifies the process for approvals of any scope or budget changes.
COMMUNICATION AND TRANSPARENCY
Regular, open communication and alignment between the project team and key stakeholders are essential to optimal project performance. Clarity around project goals and objectives, commitments to funders like foundations and donors and other stakeholders need to be well-defined and communicated. Project performance is anchored on three key drivers: scope, budget and schedule. Alignment of the entire project team on these three elements and awareness of any risks or new developments that may impact these drivers are critical to successful project delivery and are
facilitated by regular, real-time reporting on project status to stakeholders.
PROJECT SUCCESS
At first glance, these practices may seem basic and widely adopted, particularly for larger capital projects that typically follow rigorous project management processes and control measures for scope, schedule, budget and risk profile. However, these principles need to apply to any project, in any organization, regardless of size and value. Renovation projects in operating hospitals are especially complex and challenging, with many moving pieces, making solid project controls more critically important. Implementing these measures at NYGH significantly improved project delivery, as well as the credibility and trust between clinical programs, project teams, leadership teams and external stakeholders.
The construction industry is facing unprecedented challenges, including cost escalation, workforce shortages and supply chain disruptions. These factors create a perfect storm that underscores the need for solid project management processes.
But is this enough?
As the healthcare construction market evolves, innovative approaches to project delivery and management are essential. Developing teams focused on a common purpose is becoming one of the greatest determinants of success in project delivery. A renewed focus on the ‘project team’ may be at the heart of project management 2.0 — a topic for another day.
Rudy Dahdal is vice-president of planning, redevelopment and clinical support at North York General Hospital, a top-ranked academic community hospital affiliated with University of Toronto. A seasoned leader and expert in capital and strategic planning and project delivery, as well as complex operations, procurement and contract negotiations, Rudy has a strong interest in creating systems and cultures of safety and high reliability. His work has focused on creating healing environments and functional spaces that optimize the patient and staff experience and improve health outcomes.
AT HOME IN HOSPITAL
Optimizing the patient care environment to enhance health outcomes, improve operational efficiency
By Barry Hunt
One learns a lot after working in healthcare for 40 years. Important things like there is never enough time, budget or staff to achieve objectives, and change is hard. But change does happen, eventually. Hospital design has come a long way. Single-patient rooms are now a standard across Canada for new builds. Bigger spaces, better materials and thoughtful designs to improve healing and patient outcomes are being implemented.
There is still a long way to go, though. New broader, bigger, strategic thinking is required to ensure a bright and sustainable future for hospitals. Items once thought too expensive or lavish are anything but when
viewed in the light of challenges faced today in productivity, throughput, bed availability, nursing shortages and hallway medicine. It’s not that hospitals can’t afford to do things better now. It has become apparent they can’t afford not to.
For example, while it may cost $5 billion to build a new hospital today, it could cost $50 billion to operate that hospital for the next 30 years. One per cent additional capital spending upfront specifically targeted to optimize the patient care environment could result in improved operational efficiency of 10 per cent. That would produce an astounding return-on-investment of 10,000 per cent — a goal worth pursuing.
Technology is key. It may sound like science fiction now but robots, artificial intelligence (AI) and automation will perform a lot of monitoring, delivery and assistance tasks in hospitals in future to improve safety, comfort and convenience for both patients and staff. To enable this future, hospitals must provide fast, secure Wi-Fi, Bluetooth and LoRaWan, as well as the supporting infrastructure to conveniently and efficiently power and charge devices, including wireless inductive charging.
Nurses are simply overwhelmed these days and every unnecessary interruption takes away from their valuable time. In most healthcare facilities, non-ambulatory patients
must page busy nurses to perform simple tasks like turning on a light or adjusting a thermostat, something that could be done bedside with an app, remote control device or voice command. Nurses are asked to fetch warm blankets or bring a glass of water, both of which could be performed by a humanoid robot. And they are required to chart everything into a workstation they push from room to room, manually recording items like medications, patient activity and vital signs. Again, undertakings that could be handled or at least assisted by sensors and AI. Plug and play integration of data from medical devices has been a yet unachieved goal despite decades of effort. AI offers the promise to fast track and standardize data integration from different devices from different models from different manufacturers.
Hospital acquired infections (HAIs) affect patients and staff, leading to both bed and nursing shortages. With the onset of COVID, the HAI problem has gotten significantly worse. One-third to half of monthly COVID patients in Canadian hospitals are reported by the Public Health Agency of Canada to have acquired the virus while in hospital. And the mortality rate of HAI-COVID can be as high as 10 per cent or more.
Patients and staff can be shielded from exposure to pathogens in air, water and surfaces with technology. Eliminating environmental transmission of disease may reduce average length of stay by 20 per cent or more, freeing up the same percentage of hospital beds. Displacement ventilation can safely remove warm exhaled aerosols that rise to the ceiling in the thermal plume. Upper air ultraviolet (UV) disinfection can improve patient room air exchanges from six per hour to 50 or 100 equivalent air changes per hour. AutoUV can virtually eliminate the risk of exposure to pathogenic bioaerosols liberated from toilets, showers and drains in bathrooms. FarUV can greatly reduce the risk of exposure to airborne pathogens in elevators, waiting rooms and other occupied spaces. Self-disinfecting sinks dispensing reactive oxygen species (ROS) water can remove the risk of waterborne and drain-borne pathogens found in slimy biofilms, while eliminating clogged sinks. And self-disinfecting surfaces that include copper or copper ions can rapidly disinfect high-touch surfaces like over-bed tables, bed rails and door handles 24-7.
“HUNDREDS OF STUDIES HAVE SHOWN THE METAL’S EFFECTIVENESS IN CONTINUOUSLY DISINFECTING SURFACES IN HEALTHCARE SETTINGS, YET MOST HOSPITALS HAVE NOT ADOPTED THIS SIMPLE APPROACH TO KEEPING SURFACES SAFE.”
Patients and staff can both be protected from the harmful health effects of inhaling cleaning and disinfecting chemicals by switching to non-toxic alternatives like electrolyzed water, ROS water or ozonated water. As an added benefit, these products are generally safe for use, food-safe, environmentally friendly, less expensive and more effective against biofilms. They can also safely be used bedside by the patient, family or support persons as a supplement to staff cleaning and disinfection.
Patients can speed healing with daily doses of sunshine or, alternatively, penetrating infrared and near-infrared technology designed to improve vascular flow, cell signalling and defence, and cellular production of ROS — the body’s self-manufactured disinfectant.
Does all this sound like science fiction?
Maybe so, but many of these ideas have already been tested in healthcare settings for years or adopted in other sectors.
According to MadeinCa.ca, a website that compiles smart home technology statistics in Canada, three-quarters of homes already have at least one smart home device installed and the number of devices is expected to triple over the next five years. Ninety-two per cent of Canadians have smartphones that could serve as a familiar interface for patients if provided an easily downloadable app. For example, some hotels now use a QR code to lead patrons to download an app that allows remote control of room lighting and thermostat controls. Amazon’s virtual assistant technology Alexa may be provided as an information and communication interface to facilitate room service, reservations and checkout.
There is no shortage of innovation that can be adopted by hospitals but there is also no scarcity of challenges to implementation. Healthcare is a big ship that resists change. Upper air UV was first shown to be preventive against transmission of airborne disease in schools in the 1930s, but still isn’t in wide-
Nurses are required to chart everything into a workstation they push from room to room, an undertaking that could be handled or at least assisted by artificial intelligence.
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spread use in hospitals. Copper was registered as a biocide in 2008. Since then, hundreds of studies have shown the metal’s effectiveness in continuously disinfecting surfaces in healthcare settings. Yet most hospitals have not adopted this simple approach to keeping surfaces safe. AutoUV, invented in Canada, has been available for a decade now. Numerous studies have shown its ability to rapidly and effectively disinfect both air and surfaces. And while well-recognized and supported by the Ministry of Health in Ontario, and regionally throughout the country, the supply of AutoUV to healthcare has been interrupted for more than three years by a new requirement from Health Canada’s Pest Management Regulatory Agency to register UV devices prior to sale. Selfdisinfecting ROS water sinks, also created in Canada, have been commercially available since 2016. Third-party laboratory tests have been further augmented by almost a decade of real-world application. Self-disinfecting sinks have found success regionally but, despite the disturbing trend of rapidly rising high mortality sink-related disease transmission in hospitals, are not yet promoted as a national standard of care. FarUV, a more recently developed technology designed to be used in occupied areas, has demonstrated efficacy and safety when employed in spaces with good ventilation. However, it will likely require more time and study before widespread adoption, notwithstanding the promise of efficiently providing airborne protection equivalent to between 100 and 1,000 air changes per hour. And, of course, FarUV devices will first need to be registered by Canada’s pesticide regulator, a process that could take several years.
Overcoming the headwinds of change is both the challenge and opportunity for anyone working in the hospital infrastructure field, including facility managers, engineers, architects, ministries of health and others. Change means facing the unknown, taking a stand and sometimes pushing the envelope or going out on a limb to do the right thing. In the words of a well-known, recently retired leader in healthcare facility management who was asked why he pushed so hard in his career to do things right: “Someday my family and I are going to need this hospital.” That day is coming for everyone.
Barry Hunt is co-founder of the Coalition for Healthcare Acquired Infection Reduction, retired from an industry career developing solutions for healthcare and an active volunteer contributor to CSA standards and other organizations.
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Wednesday January 22, 2025
Capital Planning, Project Finances and Budget Development
Speaker: Melissa Jackson, MBA, SCM, Business Development Manager, KineEc GPO
Wednesday February 26, 2025
Enrich PaEent Experiences by Leveraging Technology and UElizing PredicEve AnalyEcs
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Wednesday March 19, 2025
Safety 101 … According to the CSA Standards … You Don’t Know What You Don’t Know
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Wednesday April 23, 2025
Structural Upgrade of Pre-Code Hospital Building to Meet Modern Safety and OperaEonal Standards
Speakers: Jack Guo, PEng, PhD, CBCI, Principal, KineEca Risk Li Ming Tang, Peng, Vice-President of Structures, EXP ConsulEng Ltd.
Wednesday May 21, 2025
CSA Z462 2024 EdiEon Significant Impacts for Hospitals
Speaker: Terrence Becker, B.A. Applied Science, Electronic InformaEon System Engineering, Electrical Safety Specialist, Management Consultant, TW Becker Electrical Safety ConsulEng Inc.
Wednesday June 18, 2025
Flooring and CSA Z8000 Canadian Health Care FaciliEes Planning, Design and ConstrucEon
Speaker: Mona Narayan, Western Regional Sales Manager, Canada, Forbo Flooring Systems
Wednesday October 15, 2025
InfecEon PrevenEon and Control
Speakers: Andrew Rodrigues, PMP, B. Eng., MHA, Senior Project Manager, Colliers Project Leaders Natalie Goertz, RN, BScN., CIC, IPAC Consulting Lead, Principal, IPAC Consulting
Wednesday November 19, 2025
Improving Energy Efficiency While Saving Precious Real Estate and Reducing OperaEonal Costs: How Wastewater Heat Recovery Helped Toronto Western Hospital Achieve All Three
Speaker: Ed Rubinstein, BSc, MSc, CEM, Vice-President of Business Development, Noventa Energy Partners
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LONG-TERM CARE OF THE PLANET
Building materials play role in mitigating embodied carbon in healthcare facilities
By Jay Burtwistle & Éléonore Leclerc
As the impacts of climate change continue to accelerate, the associated complexities deepen. There needs to be greater emphasis on addressing the root causes of climate change in a holistic way. Nowhere is this more apparent than in healthcare projects, which aim to deliver health and well-being outcomes while limiting the associated impacts on the planet of operating these facilities.
Over the past decade, much has been learned and advanced in reducing the operational impacts associated with buildings. Additionally, various codes and standards have continued to drive ever greater reductions in operational emissions.
As operational carbon has been gradually reined in by these codes, there has been a corresponding recognition that building materials have a considerable effect on the
planet and on a facility’s overall carbon picture. However, there are several unique considerations in the healthcare context that influence the ability to reduce embodied carbon emissions.
LIFE CYCLE ASSESSMENT
A life cycle assessment (LCA) is the process by which the associated impacts for a product, process or service can be quantified over
Rendering courtesy Stantec/HDR Architecture Associates Inc.
the stages of its life. The International Organization for Standards (ISO) has outlined two ways (14040 and 14044) to help define and describe LCAs consistently across all markets and applications.
ISO 14040 defines the system boundary of whole building LCAs (wbLCAs) according to several stages. Once someone has performed a LCA on specific products and developed results into environmental product declarations (EPDs), software can help aggregate the EPDs and incorporate all building products within the scope of analysis to determine the overall environmental impacts of a building in several categories. These categories vary depending on the methodology employed. For the purposes of an embodied carbon analysis, the global warming potential (GWP) indicator, which is a measure of the kilograms of carbon dioxide equivalent emissions per functional unit of product or building, is of concern.
There are many LCA tools in the market right now that can help projects analyze strategies, including OneClick LCA, Tally, Forma and Athena Impact Estimator, among others. It is recommended that teams engage a subject matter expert early on to help develop a robust LCA model capable of informing early-stage design.
PRELIMINARY INTERPRETATIONS
Using OneClick LCA as the software on a long-term care project, Stantec was able to develop results from the material quantities in the preliminary costing and create an informed analysis of different strategies to reduce the overall embodied carbon.
From this preliminary analysis of the baseline, it was learned that the majority of the embodied carbon of this project (76 per cent) was occurring during the product raw resource supply and manufacturing (A1-A3) life cycle stages. This informed the design team that they should target materials that have a carbon intensive manufacturing process. An additional 16 per cent was from transportation to the site as its location is quite rural. The project team could consider transporting materials by rail or barge to reduce these emissions, if practical to do so.
The project was analyzed through a second lens, assembly classification, which
showed 56 per cent of the total embodied carbon was in the foundations and horizontal structure (slabs) and another 18 per cent was in the columns and vertical structure, which were all concrete for the baseline design. This pointed the team in the right direction for early analysis of significant reductions by targeting these most intensive assemblies.
UNIQUE CONSIDERATIONS
Through working on the long-term care project, and several other healthcare projects throughout British Columbia, a number of considerations have arisen in relation to reducing the environmental impacts of these projects, especially as they relate to embodied carbon. The first two,
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climatic data and indoor environment, are relatively minor implications in relation to embodied carbon but bear contemplation during early design stages. Most of the considerations fall under a broad topic called ‘materiality.’
FUTURE CLIMATE DATA
A reoccurring question on several projects has focused on what climatic data to use as baseline for the design of that project. This has significant implications for the resilience of the project over the long term.
Various future climate models will require increases in heating, ventilation, and air conditioning (HVAC) equipment, consequently raising the operational and embodied carbon from oversizing equipment or providing additional measures to reduce overheating, such as solar shading devices.
CONTROLLED ENVIRONMENT
Unsurprisingly, healthcare environments require a greater level of control over the indoor thermal environment. However,
several studies relate the importance of an occupant’s ability to exercise control over their own environment through operable windows or accessible thermal comfort controls, along with having access to daylight and views. Examining this balance through the lens of embodied carbon, operable windows and more windows equate to an increase in embodied carbon, though results may vary depending on the embodied carbon intensity of the project’s wall assemblies and window-to-wall ratio. To understand this impact, an embodied carbon analysis should be included as design decisions are made.
BUILDING MATERIALS
Sensitivity analysis can be used within LCAs to determine which building materials are the least impactful from an embodied carbon perspective. However, material choices are limited in healthcare due to several reasons.
It is important to establish the classification of the project as part of its vision since this relates to functionality after an event for residents and the surrounding community. This classification has a significant impact on the structural systems and specifications, which will in turn impact the strategies to reduce embodied carbon on a project. The higher the classification, the more material (or stronger material) required in the structure of the building, so owners and design teams should weigh the classification carefully against climate and carbon goals.
In addition to resilience of the whole building, resilience of the interior environments can also have a significant carbon impact. One analysis Stantec performed on a laboratory building indicated the resilient flooring, which would normally be excluded from a typical wbLCA as it is part of the interior finishes, would have accounted for approximately 10 per cent of the project’s overall embodied carbon. Project teams should consider eliminating additional interior materials where possible and rely on the durability of finished structural materials, such as concrete, steel and mass timber.
One of the most common strategies currently being considered in projects to reduce embodied carbon is employing mass timber structural systems for all or part of the building’s super structure. Several considerations that impact this choice in healthcare projects include biophilia, vibration and acoustics.
Meaning a love for nature or living things, biophilia has gained momentum in the built environment from many studies on how natural materials or even images of nature in buildings
Views of a long-term care facility that was the subject of the life cycle assessment analysis. Renderings courtesy Stantec
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have a positive impact on the well-being of occupants.
Structural vibrations affect building occupants in several ways, as well as sensitive imaging equipment in healthcare settings. If a mass timber structure is being considered, which generally has more vibration, designers need to coordinate with the structural engineer to develop a common understanding of the vibration requirements of the project — and potentially individual spaces within it — and consider stiffening structure or using a hybrid approach where there is low tolerance for vibrations.
Acoustic performance of mass timber structures is another consideration, related to vibration. Although a completely mass timber structure will perform generally worse than stiffer, denser materials, there are several strategies available to engineers to help mitigate acoustic concerns. These can often include the introduction of technologies like special acoustic layers in floor assemblies to help reduce or eliminate sound transmittance between spaces.
Jay Burtwistle is an associate sustainability consultant at Stantec. He has experience with sustainability certification systems, environmental analysis, including daylighting and embodied carbon assessment, and systems thinking. Éléonore Leclerc is a principal architect in Stantec’s healthcare sector. She has been involved in multiple long-term care projects and visited more than 25 exemplar long-term care facilities in 10 countries to better understand how spaces should be designed to support seniors in the full spectrum of their life.
Extensive use of mass timber and timber finishing in a proposed long-term care building. Rendering courtesy Stantec/HDR Architecture Associates Inc.
AN ASTUTE IDEA
How artificial intelligence can be used to enhance HVAC efficiency
By Jennie King
Healthcare facilities are essential for patient care but also significantly contribute to greenhouse gas (GHG) emissions. As the world focuses on sustainability and climate change, finding innovative solutions to reduce the carbon footprint of these facilities is crucial. Leveraging artificial intelligence (AI) to optimize HVAC systems presents a promising approach. This solution is making significant strides in Canadian healthcare facilities, with Shannex serving as an example.
SHANNEX SAVES ENERGY
Shannex is a provider of a full continuum of services for seniors through long-term care communities. It is considered a pioneer in environmental stewardship, becoming the first seniors’ living organization in Canada to achieve ISO 50001 certification. Certification to this standard illustrates an organization’s
commitment to energy management and sustainability. In 2020, Shannex began implementing AI-driven software in seven communities across Nova Scotia, resulting in substantial HVAC reductions in total building energy consumption.
Building on this success, Shannex has now extended the use of the technology to 24 additional communities in New Brunswick, Nova Scotia and Ontario. This expansion is expected to save 3,830,000 kilowatt-hours (KWh) of energy, equivalent to powering nearly 350 homes for an entire year.
THE ROLE OF AI
AI can support not only autonomous energy control but also provide healthcare organizations with the tools to deliver precision patient comfort and alleviate day-today operator time and troubleshooting of
issues or failures. It can also be used to optimize HVAC systems by continuously adjusting setpoints for heating, cooling and ventilation based on real-time indoor data, weather forecasts and the building’s thermal mass capacity. This approach ensures a consistent indoor climate while significantly reducing energy consumption and GHG emissions.
SUSTAINABLE ADVANTAGE
The benefits of using AI-driven technology in healthcare facilities abound.
AI uses algorithms to continuously assess a building’s thermal mass. By combining this data with weather-related information, it dynamically recommissions the HVAC system every two minutes, ensuring energy efficiency and reducing emissions.
AI-driven software optimizes building comfort by fine-tuning the temperature of circulated air. It collaborates seamlessly with existing building control systems, making subtle adjustments to maintain the programmed setpoint range, resulting in a consistent, balanced temperature.
Specific areas within a healthcare facility may require unique monitoring for room air changes, temperature or room pressure. Operators can set the priority of control, ensuring AI doesn’t interfere with specific control programming. Further, AI can alert operators to excessive energy usage, temperature or overrides.
Integration is seamless, with no impact on day-to-day operations, and savings are instantaneous. Continuous reporting serves as a valuable tool for identifying HVAC issues and failures.
Jennie King is general manager at EcoPilot Canada, which focuses on artificial intelligence-driven software solutions that optimize heating, ventilation and air conditioning systems in real-time. Headquartered in Halifax, EcoPilot is dedicated to delivering substantial carbon reductions and cost savings to building owners throughout North America. The company’s iBos energy solution is used by Shannex in its long-term care facilities.
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